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Standardized induction and processing protocols exist, and sputum cell percentages—especially eosinophils—support inflammatory phenotyping, risk stratification, and selection of anti–T2 therapies. Sputum eosinophils guide inhaled corticosteroid dose adjustments and help identify severe asthma inflammation, yet routine implementation is limited by the need for specialized laboratories for sample processing. Recent approaches aim to simplify processing to expand feasibility.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/is-it-time-for-a-simplified-method-to-evaluate-airway-eosinophilia/434781/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/is-it-time-for-a-simplified-method-to-evaluate-airway-eosinophilia/434781.png","ImageObject",300,407,{"name":92,"@type":93},"Đào","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is induced sputum analysis useful in asthma?","Question",{"text":113,"@type":114},"It provides standardized airway inflammatory data through sputum cell evaluation, allowing assessment of inflammation and eosinophilic phenotypes.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How do sputum eosinophils influence asthma treatment?",{"text":118,"@type":114},"Presence of sputum eosinophils should prompt clinicians to increase inhaled corticosteroid dose, and treatment can be adjusted in step-up or step-down based on sputum eosinophil levels.",{"name":120,"@type":111,"acceptedAnswer":121},"What limits widespread use of sputum induction and processing?",{"text":122,"@type":114},"The induction step is relatively simple, but routine processing requires dedicated laboratory capability; many clinical laboratories and anatomical pathology labs are not set up to handle the complexity.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},434781,1791096745,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},1374402968488,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","ERJ OPEN RESEARCH  \nEDITORIAL P. PIGNATTI AND A. SPANEVELLO  \nIs it time for a simplified method to evaluate airway eosinophilia?  \nPatrizia Pignatti 1 and Antonio Spanevello2,3  \n1Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy. 2 Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy. 3 Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy.  \nCorresponding author: Patrizia Pignatti ( [patrizia.pignatti@icsmaugeri.it](patrizia.pignatti@icsmaugeri.it))  \nShareable abstract (@ERSpublications)  \nInduced sputum is a useful methodology to evaluate airway inflammation. Unfortunately, it is time consuming and not available in many asthma centres. New procedures could be useful to obtain airway inflammatory data. [https://bit.ly/3Huyols](https://bit.ly/3Huyols)  \nCite this article as: Pignatti P, Spanevello A. Is it time for a simplified method to evaluate airway eosinophilia? ERJ Open Res 2026; 12: 00914-2025 [DOI: 10.1183/23120541.00914-2025] .  \nCopyright ©The authors 2026  \nThis version is distributed under the terms of the Creative Commons Attribution NonCommercial Licence 4 .0. For commercial reproduction rights and permissions contact [permissions@ersnet.org](permissions@ersnet.org)  \nReceived: 4 July 2025  \nAccepted: 10 Aug 2025  \nEvaluation of sputum cells is a standardised methodology useful to assess airway inflammation. When patients are able to expectorate, spontaneous sputum can be analysed [1], while, if this does not occur, sputum can be induced with the inhalation of hypertonic saline solution. Induction and processing of sputum samples are standardised methodologies and guidelines were published many years ago in order to ensure uniform application [2–4] . Sputum cell percentages are the most useful data, from the clinical point of view, that we can obtain from sputum samples. Reference values in healthy controls with different age ranges were published and reproducibility of the data, particularly of neutrophils and eosinophils, was demonstrated [5–8] . Aligning with the type of cells present in the airways, different inflammatory phenotypes have been distinguished: eosinophilic, neutrophilic, mixed granulocytic or paucigranulocytic [9, 10] . Sputum and blood eosinophilia are risk factors for developing persistent airflow limitation [11, 12] . A mixed granulocytic airway inflammatory pattern, characterised by elevated levels of both neutrophils and eosinophils, may exert a long-term impact on lung function, especially in the context of fixed airway obstruction [13–15] .  \nThe presence of sputum eosinophils, independently from symptoms, should prompt clinicians to increase inhaled corticosteroid dose in asthmatic patients [16] . Additionally, in symptomatic patients, inhaled corticosteroid treatment can be adjusted based on sputum eosinophils (>3%) both in the step-up and in the step-down of therapy [17] . The main utility to determine inflammatory phenotypes is evident in subjects with severe asthma: to define the type of inflammation and select new therapies [18] . Sputum eosinophils are the most characteristic cells present in the airways of asthmatic patients and they are a T2 biomarker [19] . Exhaled nitric oxide fraction and serum IgE are other biomarkers of a T2 phenotype, even if they are triggered by different immunological and inflammatory processes [20, 21] . Blood eosinophils are used as a surrogate of airway eosinophils, since they usually reflect eosinophil trafficking from the bone marrow to the airways [22] . Even when all these biomarkers are low, sputum analysis allows for the detection of eosinophils in the airways, making patients suitable for an anti-T2 treatment [23] . Characterisation of the inflammatory profile of severe asthmatic patients offers the opportunity to select monoclonal antibodies with greater precision and to monitor patients even in the case of non-re","cbCaidvauJ142rzc","https://ap.wps.com/l/cbCaidvauJ142rzc","pdf",277499,"English","# Background\n## Induced sputum and phenotyping\n## Biomarkers and clinical implications\n# Implementation challenges\n## Limited laboratory capacity\n# Proposed simplified approach","[{\"question\":\"Why is induced sputum analysis useful in asthma?\",\"answer\":\"It provides standardized airway inflammatory data through sputum cell evaluation, allowing assessment of inflammation and eosinophilic phenotypes.\"},{\"question\":\"How do sputum eosinophils influence asthma treatment?\",\"answer\":\"Presence of sputum eosinophils should prompt clinicians to increase inhaled corticosteroid dose, and treatment can be adjusted in step-up or step-down based on sputum eosinophil levels.\"},{\"question\":\"What limits widespread use of sputum induction and processing?\",\"answer\":\"The induction step is relatively simple, but routine processing requires dedicated laboratory capability; many clinical laboratories and anatomical pathology labs are not set up to handle the complexity.\"}]","Is it time for a simplified method to evaluate airway eosinophilia? | PDF",1790670560]